Dr. Atul Gawande has written four New York Times bestsellers - Complications, Better, The Checklist Manifesto, Being Mortal. Here are podcast notes from his session with Shane Parrish.
"I majored in biology (Stanford), but I also majored in Political Science...A lot of things that I tried, I wasn't really made for."
(Medicine) "It was about where science meets humanity."
"I like having a lot of irons in the fire...I grew up interested in how the world works... looking for ways to understand the world."
"What does it mean to be good at what we do? I'm practicing on human beings." (So are coaches.) "Admit there's a learning curve." It also means exploring costs, new developments, interpreting data, end-of-life, etc.
"How do you cope with the reality of error?" Complexity means you are always fallible, systems are imperfect. Our workplace also determines our performance. (Some environments aren't conducive to peak performance.)
"I can borrow solutions from other places." (Coaches find other solutions regularly.)
"There is always a gap between what we think should be happening"...and what does.
"How do I make a system work when people don't want to do it?" Sound familiar? (The right solution is irrelevant without a buy-in.)
"How do you change behavior?" (Knowledge isn't necessarily the obstacle.)
"We train everybody...we still suck...we get mad." (Mad doesn't fix it.)
"Make it easier to do the right thing." (Reminds me of James Clear's Atomic Habits. Systems are paramount.)
"How will this work in OUR place?"
"Who owns responsibility for reducing mortality of ________ in your work?" Creating an owner is key in a system." (In complex systems, accountability may not be defined. He discusses M&M, morbidity and mortality conferences.)
"When we all have a piece of a problem, nobody can see where the outcome comes from."
"Mundane things" (make a difference).
- "Do you hire for talent to achieve desired outcomes?"
- "Do you have measures of performance?"
- "Do you have (targets) goals and objectives?
- "Do you standardize operations?"
"We’ve been fantastic at breakthrough innovation and we’ve had no real understanding of follow-through innovation. I think it’s partly that the follow through innovation can seem like it’s only about nuts and bolts, instead of about recognizing that there are ways that you can actually influence and have control, some degree of control, with regard to the world around you." (Checklists are part of follow-through innovation.)
Where are the problems in human systems - the bottlenecks and complexity? "Screaming at people to wash hands doesn't work." (Reminds me of the Robert Fulghum paradigm, "All I Really Need to Know I Learned in Kindergarten." We needs systems that encourage people to do the right things.)
"Why is applying knowledge hard?" (Parrish)
"Why do we fail at anything we do?" "For most of human history, for like 99.99% of it, our world was governed largely by ignorance. We did not know the diseases that could afflict the human body or understand them, let alone what to do about them. We didn’t understand how societies rose and fell. We didn’t understand how economics worked, even in the most basic components."
What do we do that has little value? The fact of rising health care costs is not the problem. What is the problem is, how much of the costs are rising that are not actually connected in any way to value? "What are we doing...and is it actually benefiting people?" (How much or our practice, our system adds no value to our players or to our team? That's where our editing matters.)
"How do we manage complexity (and fallibility)?"
"My responsibility is that we have to be aiming for perfection."
Surgeons have an incredible confidence, yet humility is expected.
"A high reliability organization is where people are obsessed with failure (to fix it)."
"Presidents acknowledging mistakes is seen as weakness." (Mistakes are unavoidable. Learning from mistakes is partly a choice.)
"Subverting the system...does get you fired."
Psychological safety occurs when people at different levels have a voice. Introductions of each participant help open discussion. (Eric Spoelstra's culture of disagreement)
"You need a coach" (even if you're Roger Federer). "The coaching model beats teaching model." Coaching is different than mentoring. Observing helps get a better handle on reality as "a coach offers you an external view of your reality" and how to achieve your goals.
To improve teaching, you need to give trainees more leeway to struggle but they still need correction.
"My primary duty is to the benefit of this patient now." (Contrast with team sports.)
"People have goals and priorities about their end of life...we rarely ask." (Do we ask players what their goals and priorities are?)
Cost, care, and suffering are often unaligned with patient preferences because of this.
Summary (Super 7):
- What does it mean to be good?
- How do I make a system work when people don't want to do it?
- Why is applying knowledge hard?
- We need performance metrics.
- What do we do that has little value?
- High performance organizations are obsessed with failure.
- You need a coach. (Gawande is famous for hiring a coach to watch his surgery.)
Lagniappe: Hat tip: Brook Kohlheim
Great players are great for a reason.Found this in my phone and wanted to share one of THE BEST examples of why @Dame_Lillard has become the player he is today!— Phil Beckner (@PhilBeckner) July 8, 2020
This was written a few years ago by a college coach who wanted to share what he learned from watching Dame workout at 10:30pm in Vegas one night in July. pic.twitter.com/QWinQeLuIm
